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Examining Hillary's doctor and health report

A number of physicians, including me, have dared to suggest that Hillary Clinton might have a serious health problem that would affect her ability to serve as president, and they have suggested some things that it could be, based on past known diagnoses and current public observations recorded on video. All have stated that to make an actual diagnosis, you need to see the patient – and all the records.

Dr. Drew lost his TV show, and others got lambasted in the mainstream media and the Twittersphere. How dare we diagnose Mrs. Clinton without seeing her? It’s nothing but a conspiracy theory.

It’s so ironic. Patients are being diagnosed every day, and treatments prescribed – or denied – by people who have not seen the patient. There’s telemedicine, and doctors signing off on patients seen only by a “mid-level.” Then there are people with no medical training at all, making life-changing decisions about insurance coverage. Where are Hillary’s supporters when that happens? They probably say, in other contexts, that you can’t trust those greedy doctors who actually see patients and get paid for it.

Then there are medical experts for malpractice attorneys, peer reviewers, licensure boards and prosecutors judging doctors by evaluating how they treated a patient. They might not even have a video or a photograph, just a medical record and possibly an anonymous complaint.

One of the most common reasons for suing doctors is failure to diagnose. Saying that a patient does not have cancer, or does not have seizures, or is in fine health is also making a diagnosis.

So far, I have not seen a doctor putting his reputation on the line by writing, “I have read all the available medical reports and looked at the photographs and videos, and my diagnosis is that Mrs. Clinton is in fine health.” No doctor has said, “If I were at an event and saw someone displaying the signs captured on video, I would ignore it. I would not bring the person a chair, or ask, ‘Are you OK?’ or make sure she had a ride home.”

Only one doctor to my knowledge has publicly proclaimed Mrs. Clinton’s fitness: Dr. Lisa Bardack, her personal internist. Let’s give the doctor the benefit of the doubt – not always done in peer review – and assume she has supporting evidence that the Clinton campaign did not see fit to release to the New York Times. Let’s review Dr. Bardack’s letter of July 2015, as if it concerned Mary Jones, who needs medical clearance to drive a school bus. (Remember, no credentials are needed to criticize a doctor.)

In the actual record, as opposed to a summary letter, I’d expect to find a weight. Photographs show evidence of substantial rapid weight gain. If true, it requires an explanation.

Since Mrs. Jones has had dizziness and falls, did the doctor check her blood pressure and pulse lying down and then standing up?

The patient is on Coumadin for recurrent clotting problems. How often is the INR (a measure of clotting function) checked? Has Mrs. Jones been instructed about Coumadin interactions with some 800 drugs as well as fruits and vegetables (kale, avocado, grapefruit, etc.), alcohol and herbs (oregano, thyme, basil, etc.)? The INR can change unexpectedly, but even if stable and within the desired range, the patient is at risk of clotting or hemorrhage.

About that transverse sinus clot: How does Dr. Bardack know it completely dissolved? It usually doesn’t. Did Mrs. Jones have a venogram or MRV? Veins are often damaged by a thrombus – a patient might have a swollen ankle for life. A swollen brain can be fatal. With impaired venous drainage from the brain, a patient gets intracranial hypertension. Symptoms include headache, double vision, visual impairment, nausea and vomiting and dizziness. The record should contain a good eye exam, looking for swelling of the optic nerve head. But many patients (maybe 90 percent) with intracranial hypertension don’t show that. The definitive test is a lumbar puncture (spinal tap) to measure opening pressure. But no one is going to do an LP in somebody who’s on Coumadin.

And the severe concussion? How is Dr. Bardack sure there is no persistent brain damage? Has Mrs. Jones had formal cognitive testing, as done in athletes? Has anything changed on a more recent examination? Has she had an MRI with DTI, which shows connecting pathways in the brain? Have reports of confusion or difficulty arousing her from a nap been investigated?

Then some videos have led some to suspect seizures, a known complication of traumatic brain injury. Was an EEG done, just in case – for the sake of the children?

And did Dr. Bardack’s “normal physical examination” include a detailed neurologic exam? Did the doctor check eye movements, gait, Romberg sign (ability to stand with feet together and eyes closed), muscle strength, motor coordination, vibratory sensation, normal and potential abnormal reflexes, memory, etc.? Did she obtain a neurology or neurosurgery consult?

If Dr. Bardack did not check for all these things, I’d judge her evaluation of Mrs. Jones for driving a school bus to be inadequate.

I challenge any doctor to say that any one of these items is unimportant in a person with Mrs. Clinton’s history and recently reported signs who aspires to a position as a bus driver – or U.S. president.

Note: Dr. Orient is a member of the Association of American Physicians and Surgeons, AAPS.